Provider Demographics
NPI:1003040114
Name:BROOKS, MAXINE L (CNM, NP)
Entity Type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:L
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:MRS
Other - First Name:MAXINE
Other - Middle Name:L
Other - Last Name:BROOKS WALSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM, NP
Mailing Address - Street 1:11247 QUEENS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7417
Mailing Address - Country:US
Mailing Address - Phone:718-263-2986
Mailing Address - Fax:718-544-6475
Practice Address - Street 1:11247 QUEENS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7417
Practice Address - Country:US
Practice Address - Phone:718-263-2986
Practice Address - Fax:718-544-6475
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363LW0102X363LW0102X
NY367A00000X367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife